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CENTER FOR HEALTH INFORMATION AND ANALYSISCOST REPORT INSTRUCTIONS: Nursing Services cost REPORT NONCONTINUOUS SKILLED NURSING AGENCIES (CAN) HANDSOME HEALTH AGENCIES (HHA)March 2023TABLE OF CONTENTS IMPORTANT
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How to fill out epsdt-skilled nursing services

01
To fill out EPSDT-skilled nursing services, follow these steps:
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Obtain the EPSDT-skilled nursing services form from the relevant healthcare provider or agency.
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Provide your personal information, including your name, address, phone number, and date of birth.
04
Fill out the section that requires information about the patient's medical history and current condition.
05
Specify the skilled nursing services needed, including the frequency and duration of the services.
06
If applicable, provide any supporting documentation or medical reports to justify the need for skilled nursing services.
07
Review the completed form for accuracy and completeness.
08
Sign and date the form.
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Submit the filled-out form to the appropriate healthcare provider or agency.

Who needs epsdt-skilled nursing services?

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EPSDT-skilled nursing services are typically necessary for individuals who:
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- Are under the age of 21.
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- Have a medical condition or disability that requires skilled nursing care.
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- Require ongoing monitoring and intervention to maintain their health and well-being.
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- Have complex medical needs that cannot be adequately addressed by non-skilled caregivers.
06
Examples of individuals who may need EPSDT-skilled nursing services include children with chronic illnesses, individuals with severe disabilities, or those recovering from major surgeries or injuries.

What is EPSDT-Skilled Nursing Services - DHCS - CA.gov Form?

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EPSDT-skilled nursing services refer to a program under Medicaid that ensures children receive comprehensive and preventive healthcare services, including those that are required for their specific needs if they are eligible.
Healthcare providers or facilities that deliver EPSDT-skilled nursing services to eligible Medicaid recipients are typically required to file for these services.
To fill out the EPSDT-skilled nursing services form, providers must complete all required sections, including patient information, services rendered, dates of service, and any supporting documentation as per the guidelines provided by Medicaid.
The purpose of EPSDT-skilled nursing services is to ensure that children receive necessary healthcare services early and continuously, including screenings, diagnoses, and treatment of health issues to promote overall well-being.
The information that must be reported includes the child's Medicaid number, details of the services provided, dates of service, provider information, diagnoses, and any other relevant medical records.
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